Endometriosis is largely prevalent in women in reproductive age group with 1 in 10 women suffering from it. Worldwide, 10% women have endometriosis – that’s an estimate 176 million. Prevalence of endometriosis in women with infertility can be as high as 30% to 50%. Nearly 26 million Indian women between 18 and 40 years suffer from endometriosis.

Endometriosis is a common condition where tissues / cells that line the womb (the endometrium) are found outside the womb. These cells can be found in many different areas of the body, including ovaries and fallopian tubes, lining of inside of abdomen and even bowel or bladder. Under hormonal influence, these cells also build up, break down and then bleed akin to those in womb. Unlike cells in womb that leave the body during menstrual cycle, this blood has no way to escape. This causes inflammation, pain and formation of scar tissue in area where they are deposited. This, in turn, results in conditions like painful periods, chronic pelvic pain and subfertility issues involving ovaries and tubes.

Over 17% to 44% of women afflicted with endometriosis suffer from ovarian endometrioma. Cells deposited on ovaries bleed and discharge thick, brown blood which resembles colour of chocolates and form cysts on ovary known as chocolate cysts. Cysts can grow up to 15-20cm and may cause reduction of natural fertility, chronic pelvic pain and painful sex.

Young girls coming for infertility treatments have been diagnosed with chocolate cysts. Patients coming for infertility investigations sometimes realise their endometriosis has advanced to stage III/IV. It occurs more commonly in fertile age period of 18 and 40 years and is also noticeably prevalent among teenagers.

It is largely characterised by extremely painful periods, chronic pelvic pain, bleeding in between period cycle, pain during and after intercourse, difficulty in getting pregnant and sometimes cyclical painful defecation / urination. If such pains are prolonged and forces long-term absenteeism from work or college, medical advice needs to be sought.

In most cases, ultrasonography is carried out to ascertain presence of chocolate cyst and to differentiate it from other types of ovarian cysts.

The author is a consultant gynaecologist at Nanavati Super Speciality Hospital